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After the nurse has finished teaching a patient about self-administration of the prescribed aspart insulin, which of the following patient actions indicate good understanding of the teaching?
- A. The patient avoids injecting the insulin into the upper abdominal area.
- B. The patient cleans the skin with soap and water before insulin administration.
- C. The patient places the insulin back in the freezer after administering the prescribed insulin dose.
- D. The patient pushes the plunger down and immediately removes the syringe from the injection site.
Correct Answer: B
Rationale: The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and rinsing with water is adequate. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.
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The nurse administers intramuscular glucagon to a patient who is unresponsive for treatment of hypoglycemia. Which of the following actions should the nurse take after the patient regains consciousness?
- A. Assess the patient for symptoms of hyperglycemia.
- B. Give the patient a snack of crackers and peanut butter.
- C. Have the patient drink a glass of orange juice or nonfat milk.
- D. Administer a continuous infusion of 5% dextrose for 24 hours.
Correct Answer: B
Rationale: Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. A starch snack is recommended. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.
To evaluate the effectiveness of treatment for a patient with type 2 diabetes who is scheduled for a follow-up visit in the clinic, which of the following tests will the nurse plan to schedule for the patient?
- A. Urine dipstick for glucose
- B. Oral glucose tolerance test
- C. Fasting blood glucose level
- D. Glycosylated hemoglobin level
Correct Answer: D
Rationale: The glycosylated hemoglobin (Hb A1C) test shows the overall control of glucose over 90-120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control once diabetes has been diagnosed.
The home health nurse is providing teaching to a patient and family about how to use glargine and regular insulin safely. Which of the following actions by the patient indicates that the teaching has been successful?
- A. The patient administers the glargine 30-45 minutes before eating each meal.
- B. The patient's family fills the syringes weekly and stores them in the refrigerator.
- C. The patient draws up the regular insulin and then the glargine in the same syringe.
- D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks.
Correct Answer: D
Rationale: Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, while glargine is given once daily.
The health care provider suspects the Somogyi effect in a patient whose 7:00 A.M. blood glucose is 12.2 mmol/L. Which action should the nurse plan to take?
- A. Check the patient's blood glucose at 3:00 A.M.
- B. Administer a larger dose of long-acting insulin
- C. Educate about the need to increase the rapid-acting insulin dose.
- D. Remind the patient about the need to avoid snacking at bedtime.
Correct Answer: A
Rationale: If the Somogyi effect is causing the patient's increased morning glucose level, the patient will experience hypoglycemia between 2 and 4 A.M. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night.
Which of the following actions should the nurse take first when teaching a patient who is newly diagnosed with type 2 diabetes about home management of the disease?
- A. Ask the patient's family to participate in the diabetes education program.
- B. Assess the patient's perception of what it means to have diabetes mellitus.
- C. Demonstrate how to check glucose using capillary blood glucose monitoring.
- D. Discuss the need for the patient to participate actively in diabetes management.
Correct Answer: B
Rationale: Before planning education, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be individualized to each patient.